Kidney transplant recipients (KTRs) hospitalized for COVID-19 have high rates of death and acute kidney injury (AKI), according to separate studies presented at the American Society of Nephrology’s Kidney Week 2020 Reimagined virtual conference.

The studies provide details of the clinical presentation and disease course of COVID-19 among KTRs admitted to hospitals with COVID-19, as well as patients’ comorbidities and the treatments they received.

An analysis of retrospective data from the TANGO International Transplant Consortium by Leonardo V. Riella, MD, of Massachusetts General Hospital in Boston, and colleagues found that 44 (30%) of 145 KTRs hospitalized with COVID-19 in March and April died after a median follow-up of 10 days following hospital admission for COVID-19.1 AKI developed in 46% of cases, and respiratory failure requiring intubation occurred in 29% of cases. Vinay Nair, DO, and colleagues at Northwell Health in Great Neck, New York, found that 10 (33%) of 30 KTRs admitted to hospitals in their system with COVID-19 from March 1 to April 30 died after a median follow-up of 19 days.2 AKI occurred in 39% of cases.

The study by Dr Riella’s group included 9697 KTRs followed at 11 transplant centers, of whom 145 (1.5%) were hospitalized with COVID-19. Of the 145 patients, 55% were older than 60 years and 65% were male. The median time since receiving a transplant was 5 years; only 16% had received a transplant less than 1 year from presentation.


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Common symptoms at COVID-19 onset were fever and dysnea (71%), myalgia (54%), and diarrhea (35%). During hospitalization, 83% of patients received hydroxychloroquine, 76% antibiotics, 13% tocilizumab, and 10% antivirals.

Hypertension was the most common comorbidity (95%), followed by obesity, heart disease, and lung disease, which were present in 41%, 25%, and 19% of patients, respectively, Dr Riella and colleagues reported.

The study by Northwell investigators examined data from 30 KTRs hospitalized with COVID-19. Death risk was higher if patients were admitted to a non-transplant hospital (80% vs 23%), lymphopenic at presentation (47% vs 8%), and had an oxygen saturation less than 94% on admission (100% vs 57%), Dr Vinay and colleagues reported.

During hospitalization, mortality also was higher among patients with elevated peak serum creatinine (3.2 vs 1.5 mg/dL), or if they required intubation (70% vs 14%). Increases in inflammatory markers, including peak D-dimer, peak C-reactive protein, ferritin, and procalcitonin, also predicted mortality.

The study population was 61% male, 32% male, and 32% Black. The most common symptom was cough, followed by fever, shortness of breath, and fatigue. Ten patients required ventilation. Most patients were on triple immunosuppression (94% on tacrolimus, 90% on mycophenolate, and 74% on prednisone). With respect to treatment, 93% of patients received hydroxychloroquine, 50% received azithromycin, 14% received convalescent plasma, and 10% received an interleukin-6 inhibitor. One patient received the antiviral remdesivir.

References

  1. Riella LV, Mothi SS, Akalin E, Cravedi P. COVID-19 and Kidney Transplantation: Results from the TANGO International Transplant Consortium. Presented at: Kidney Week 2020 Reimagined virtual conference, October 19 to 25. PO0765.
  2. Nair V, Jandovitz N, Abate M, et al. Risk factors for mortality in kidney transplant recipients with COVID-19. Presented at: Kidney Week 2020 Reimagined virtual conference, October 19 to 25. Poster PO0768.